In this Evidence Based area where we’re trapped in literature and administrations, we almost would forget that treating patients with ‘hands on’ interventions like acupuncture (and massage or manipulations), the effect (or efficacy) of the treatment has to be initiated right on the spot. When the patient consults you presenting with pain, discomfort, fatigue or else, we as acupuncturists have to do this something thats gonna intervene in this person to counteract and solve the aching. Apart from explaining what is happening we have to make it happen. Explanations of ‘how acupuncture or needling works’ changed over time (as theories always do), but the human body seems to respond quite consistent . So, apart from this huge amount of theoretical models and research that has to guide healthcare workers, hands on professionals have to manage skills. Its not uncommon that each practitioner develops its own favourite ‘tricks’ and abilities.
I believe that the latter ( which is also part of the EBM triad) is vastly underestimated. Not only based on my own experience but I observed this at the first edition of The Journey of the Needle. Whether it be a more traditional theory based on Qi concepts or a more biomedical oriented one, palpation in the end seems to be crucial for the final needle placement. The identification of these ‘ashi points or areas’ is the first step and often precondition for the requested outcome. Instantaneous (pain) relief can be obtained when appropriate needling is performed. This direct feedback in fact forms the cornerstone of best practice.
Besides those ‘palpation’ related diagnoses, other practitioner features like intention and needling techniques come into play in the hands on practice of acupuncture[1,2,3]. The impact on outcomes isn’t yet studied thoroughly. And should deserve more attention.
Figure extracted from ‘Precision in needling’ while needling ‘MTrP. See below for link
2. Chae Y, Olausson H. The role of touch in acupuncture treatment. Acupunct Med. 2017 Feb 1. pii: acupmed-2016-011178. doi: 10.1136/acupmed-2016-011178.
3. Precision needling in myofascial pain. Mike Cummings 2017 BMJ Blog